What are the responsibilities and job description for the Registered Nurse Transitions-of-Care Coordinator position at Skillcloud HCM?
Chest Medicine Associates
Registered Nurse Transitions-of-Care Coordinator
South Portland, Maine
Chest Medicine Associates is seeking a full-time Registered Nurse to serve as the RN Transitions-of-Care Coordinator-Pulmonary Medicine to serve as a central resource for patients, families, physicians, and hospital teams, ensuring timely follow-up, seamless communication, and coordination of complex pulmonary care.
This is a full-time, Monday–Friday daytime position with no routine evening, weekend, or holiday responsibilities. This position will be grant-supported for two years and may be contingent on renewal of grant funding.
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Registered Nurse with an active, unrestricted Maine license.
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Bachelor of Science in Nursing (BSN).
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Current American Heart Association Basic Life Support (BLS) certification.
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Minimum of two years of clinical nursing experience.
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Strong clinical assessment and telephone triage skills.
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Excellent communication and interpersonal skills.
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Proficiency with electronic health record systems and Microsoft Office applications
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Experience in pulmonary medicine, hospital medicine, case management, care coordination, and/or transitions of care is preferred
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Experience caring for patients with COPD, ILD, asthma, bronchiectasis, or other chronic respiratory diseases is preferred.
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Familiarity with pulmonary rehabilitation, home oxygen therapy, durable medical equipment, and insurance authorization processes is preferred.
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Hourly pay in the range of $40-46 depending on experience and qualifications.
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Health, Dental, Vision Insurance
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401K with match
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PTO and paid holidays
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Profit sharing
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Paid parental leave
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Tuition reimbursement
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Convenient location in South Portland, Maine
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Identify hospitalized pulmonary patients appropriate for transitions-of-care services, with emphasis on COPD and ILD.
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Collaborate with inpatient teams, case management, respiratory therapy, pharmacy, and primary care providers and coordinate timely pulmonary follow-up appointments and diagnostic testing.
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Contact patients within 24–72 hours of discharge to assess recovery, reinforce discharge instructions, and identify barriers to care.
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Perform medication reconciliation and reinforce inhaler technique and medication adherence.
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Assess oxygen, nebulizer, CPAP/BPAP, and other durable medical equipment needs.
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Facilitate referrals to pulmonary rehabilitation, smoking cessation, home health, palliative care, and community resources.
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Monitor for clinical deterioration and collaborate with providers to facilitate intervention.
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Coordinate referrals for EBUS and robotic bronchoscopy.
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Schedule procedures and required pre-procedure testing.
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Ensure required imaging and diagnostic studies are available.
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Track patients from referral through pathology results and treatment planning.
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Coordinate post-procedure follow-up and collaborate with the lung cancer screening program to facilitate timely evaluation of abnormal screening findings.
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Perform pulse oximetry testing, nebulizer treatments, medication administration, and other nursing procedures within scope of practice.
For 35 years, Chest Medicine Associates has been serving patients throughout Maine and southern New Hampshire and is devoted to specialty care in Pulmonary, Critical Care and Sleep Medicine. Joining our team as a RN Navigator offers the opportunity to work in a dynamic healthcare environment where you can make a difference in patients' lives.
Skillcloud HCM Solutions has been engaged to manage this search. NO PHONE CALLS OR RECRUITERS PLEASE.
Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, ancestry, familial status, age, physical or mental disability, pregnancy, sexual orientation, gender identity, genetic information, veteran status, or any other characteristic protected by law.